Fallon Health Clinical Pharmacist in Worcester, Massachusetts
About Fallon Health :
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit.
Brief Summary of Purpose:
Responsible for reviewing prescribed medications performing clinical and drug utilization reviews and clinical/economic evaluation of therapies and writing criteria sets for medications that have a prior authorization attached to them.
Responsible for designing and implementing clinical pharmacy programs and initiatives primarily for the PACE program. Position may require implementing programs and interventions for commercial and Medicaid products.
Perform total patient medication assessment as requested for new enrollees identifying interventions to address polypharmacy, drug-drug, drug-disease interactions, high risk medication use and non-adherence
Discuss medications with members/participants telephonically or in person
Implement programs and processes to improve medication related HEDIS and STAR measures
Identify opportunities for cost saving interventions utilizing high cost medication and medical cost lists
Review and provide clinical decisions for provider submitted prior authorizations for medically administered medications as well as pharmacy related appeals and grievances
Develop prior authorization criteria for new to market medications
Review and update existing prior authorization criteria
Present clinical and economic data to Pharmacy and Therapeutics committee
Perform in-services and provide drug information to PACE team and other internal and external stakeholders as needed
Participate in managing issues with medical and specialty drugs
Education, Licenses, certification and experience requirements:
Education : PharmD required
License : Current license to practice as pharmacist in Massachusetts without restriction
Certification : CGP Preferred
Experience : 5 years with at least one year in a managed care environment; 1-2 years Professional experience practicing as a clinical pharmacist
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Posted Date 2 months ago (4/1/2020 9:33 AM)
Job ID 5967
# Positions 1